The development and clinician-adoption of methods for generating clinical notes usable in electronic health record (EHR) systems remains a major challenge and important focus for researchers in biomedical informatics. While numerous method for documenting clinical care exist, including handwriting on paper, dictation with subsequent transcription and computer based documentation (CBD), research evaluating how well these methods support EHR adoption is limited. Each documentation method has relative strengths and weaknesses in terms of usability, ability accurately and reliably to reflect the clinical facts, efficiency to access and use, ability to contribute information to EHR systems, and ability to support reuse of the information the resultant notes contain for other purposes. Empiric research investigating documentation methods should evaluate how they impact outcomes associated with clinician adoption of and integrating notes into EHR systems. In the current project, the investigators will extend and apply a framework for evaluating documentation methods. The investigators'previous work has demonstrated that documentation methods should be accurate, efficient, permit them to express their thoughts and impressions, and be easy to use. Based on this, the investigators propose to test in two specific aims the hypothesis that generating clinical notes by using CBD systems increases accuracy, decreases documentation time and expressivity, and does not impact satisfaction when compared to handwritten or dictated and transcribed notes. In the first specific aim, the investigators will use unstructured task analysis and focus groups to develop and validate a set of standardized patient encounters that will allow a rigorous evaluation of different documentation methods in a tightly controlled setting. In the second specific aim, the investigators will use the standardized patient encounters to compare two CBD methods to handwriting and to dictation on documentation accuracy, expressivity and time efficiency, patient and subject satisfaction, and documentation-related workflow tasks. These outcomes will be measured from note content, structured task analysis of video recordings, and questionnaires. The proposed project will transition the PI from his current National Library of Medicine supported period of career development to an independent informatics investigator.